Dental Coverage, Fall 2014 - Spring 2015

Dental coverage is included as part of the Berkeley Student Health Insurance Plan (SHIP). All UC Berkeley students enrolled in SHIP automatically will receive benefits covering preventive and general restorative dental care.

Metlife is the dental insurance provider for SHIP students. Note that dental care is not provided at the Tang Center. SHIP members can select from a wide choice of local dentists, listed on the MetLife website.

Group and ID Numbers

MetLife PDP Plus Group plan number: 151638.

Member ID number: Your Metlife ID number is the nine digits after the "W" on your Aetna ID card.

Dental Benefits Summary

There is a $1,000 academic year benefit maximum (August 15-August 14). If you choose an out of network dentist your coverage is reduced to a $750 academic year benefit maximum.

If the care isprovided by a…

Dentist who is an in-network MetLife PDP Plus Dentist the plan covers…

Dentist who is not an in-network MetLife PDP Plus Dentist the plan covers…

Preventive and Diagnostic Services:

Oral exams
(2 per year)

Cleanings
(2 per year)

Fluoride treatment

X-ray Bitewing (once per year)

X-ray Full mouth (once every 5 years)

100%
of negotiated fees that participating dentists have agreed to accept as payment in full

80%
of reasonable and customary charges

Basic Operative and Restorative Services:

Fillings

Simple extractions

Oral surgery

Periodontics

Endodontics

80%
of negotiated fees after a $25 annual deductible

60%
of reasonable and customary charges after a $50 annual deductible. Co-payments will be higher with non-Network providers than if you use an in-Network PDP Plus dentist

Major Services

Prosthodontics

Inlays/onlays

Crowns & cast restorations

70%
of negotiated fees after a $25 annual deductible

40%
of reasonable and customary charges after a $50 annual deductible.Co-payments will be higher with non-Network providers than if you use an in-Network PDP Plus dentist

Dental coverage is provided through the MetLife PDP Plus plan. With this plan, you select a provider from a nationwide network of 90,000 MetLife PDP Plus Dentists, over 100 of whom are located within five miles of campus. When you make your appointment, let the dentist know you have coverage through MetLife.

You do not need to pre-select a primary dentist, carry an ID card or receive referrals for specialty care. If you visit a dentist who is not a MetLife Dentist, you will still receive benefits, but you will be charged higher out-of-pocket copayments for the services you receive.

How do I find a dentist?

There are over 100 dentists within five miles of campus who
participate in the MetLife PDP Plus plan. To find a dentist, visit
the MetLife website at http://metlife.com/dental.
If you need dental care when away from campus, you may
choose from dentists nationwide. You have the freedom to
choose any dentist at any time. You do not need to visit the same
dentist every time. See the local MetLife Dentist List (pdf).

Do I need to file a claim after my visit?

Dentists will file a claim directly to MetLife. If you are responsible
for any portion of the charges, you will be expected to pay that
amount at the time of service. Your dentist may ask for the plan
group number or your member ID number.
Please call the Student Health Insurance Office at (510) 642-5700 if you do not know your ID number. If you visit a dentist who is not a MetLife dentist, you may need to
pay all charges, and then file a claim for reimbursement. You may
print out a claim form at http://metlife.com/dental or call (800) 942-
0854 to have one sent.

Can I find out how much services will cost prior to treatment?

Yes. You may have your dentist request a pretreatment estimate
to determine what services the plan will cover and at what
payment level. We strongly recommend a pretreatment estimate if
the services are expected to cost more than $200. With the
pretreatment estimate, you’ll know exactly what your payment
responsibilities are and can discuss treatment options.

Can I waive the dental plan?

Dental coverage is available as part of Berkeley SHIP. If you are enrolled in SHIP, you automatically receive dental coverage. You cannot enroll in or waive dental coverage separate from SHIP.